Follow @AIDSadvocacy | #2019USCA 1 Federal HIV/AIDS Funding Whats - PowerPoint PPT Presentation

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Federal HIV/AIDS Funding What’s Been Done, Where We Are, and What’s Next? USCA 2019 Washington, DC September 7 th , 2019

Workshop Outline • Presentation • The Current Budget Situation • Appropriations Update • Next Steps • Panel Discussion • HIV Prevention • Housing • Ryan White HIV/AIDS Program • HIV/AIDS Research • Minority AIDS Initiative • Sex-Ed Programs • Viral Hepatitis Prevention • STD Prevention

The Current Budget Situation Carl Schmid Deputy Executive Director The AIDS Institute

FY 2018 Federal Budget - $4.1 Trillion Net Interest Net Interest Defense $325 b $325 Billion $623 b 8% 8% 15% Social Discretiona Security ry Spending $982 b Nondefense $1.3 24% $639 b Trillion 16% 31% Mandatory Spending $2.5 Trillion Other 61% Medicare $570 b $582 b Medicaid 14% 14% $389 b 9% Source: Congressional Budget Office

FY 2018 Discretionary Spending $1.3 Trillion Source: Congressional Budget Office

Total Deficits and Surpluses CBO Projects $12.2 trillion deficit by 2029 Source: Congressional Budget Office

Federal Debt Held By the Public Source: Congressional Budget Office

Projected Government Spending Note: Projections were made prior to the FY2020 and FY2021 budget agreements and do not take into account increased spending caps Source: Congressional Budget Office

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Appropriations Update Nick Armstrong Policy Associate The AIDS Institute

Appropriations 101 Key Terms • Discretionary Spending – funding that is subject to the annual appropriations process • Mandatory Spending – funds automatically spent based on law and not subject to Congressional approval (Medicare, Social Security, etc.) • Appropriations Bills – laws passed by crafted and passed by Congress that legally obligate funding levels for discretionary programs • Labor-HHS (L-HHS) Bill – one of 12 appropriations bills passed by Congress which funds the Depts. of Labor, HHS and Education • Mark-Up – Committee meetings where Congress reviews details of a bill, offer and debate changes, and vote to advance a bill to the next legislative step • Fiscal Year – yearly cycle of funding starting Oct. 1 st and ending Sept. 30 th 12

Appropriations 101 How the process (theoretically) works Final Bill(s) Signed Conference President’s • Negotiate Budget Congressional differences Action • Conference bill crafted President’s • 12 Appropriations • Chamber votes Budget Subcommittees • Full Committee • Statement of • Chamber votes policy Budgeting • No effect of law 13

Trump’s Proposed FY19 Budget Cuts • Proposed cuts – CDC HIV Prevention: -$40 m – CDC STD Prevention: -$5 m – NIH AIDS Research: -$89 m – HOPWA: -$45 m • Proposed Program Eliminations – Ryan White AETCs: -$34 m – Ryan White SPNS: -$25 m – SAMHSA Minority AIDS Programs: -$116 m – Minority HIV/AIDS Fund: -$54 m – Teen Pregnancy Prevention Program: -$101 m 14

Congressional Response • House and Senate level funded most domestic HIV programs • House – Opioid Related Infectious Diseases: +$20 m – HOPWA: +$18 m – Proposed Program Eliminations • Teen Pregnancy Prevention Program: -$101 m • Title X Family Planning: -$286 m – “Sexual Risk Avoidance” Abstinence -Only: +$5 m • Senate – Opioid Related Infectious Diseases: +$5 m – “Sexual Risk Avoidance” Abstinence -Only: +$10 m 15

Fiscal Year 2019 • Trump FY19 Budget – Feb. 2018 • Senate Passes L-HHS Bill – June 2018 • House Passes L-HHS Bill – July 2018 • President signs Minibus Appropriations Bill – Sept. 2018 • Two Continuing Resolutions passed • Partial government shutdown – Dec. 22, 2018 to Jan. 25, 2019 – House switches from Republican to Democratic control • Final Appropriations passed Jan. 25, 2019 16

Final FY19 Appropriations • Increases – CDC STD Prevention: +$5 m – Opioid Related Infectious Diseases: +$5 m – HOPWA: +$18 m – NIH Total: +$2 b • No proposed cuts were included in the final bill • Most domestic HIV/AIDS programs level funded – $10 m increase to “Sexual Risk Avoidance” Abstinence -Only Programs 17

FY 2019 Takeaways • There was bipartisan cooperation for L-HHS programs • L-HHS was passed with Defense, which prevented health programs from being impacted by the shutdown • Congress did not have to address Budget Caps – allowing for efficiency in the appropriations process • Proposed cuts to domestic programs were less severe than previous years • Advocacy against proposed cuts was effective 18

FY2020 – A Unique Opportunity 19

President’s FY2020 Budget we do support the administration’s plan to reduce HIV transmission 90 percent in 10 years. So, we include the administration’ s request for $120 million for programs through Health Resources and Services Administration to increase access to the ground- breaking HIV drugs and $140 million for CDC’s work in HIV outreach and disease we go even further. We provide an additional $46 million for the Ryan White program. We provide additional funds for the Minority AIDs initiative. And, we provide an additional $150 million for NIH’s HIV research to secure a vaccine or a cure. 20

The Ryan White HIV/AIDS Program FY2020 FY2019 FY2020 President’s Final House Request $655.9 m $655.9 m $677.5 m Part A (+$0.0 m) (+$0.0 m) (+21.6 m) $414.7 m $414.7 m $419.6 m Part B: Care (+$0.0 m) (+$0.0 m) (+$4.9 m) $900.3 m $900.3 m $912.0 m Part B: ADAP (+$0.0 m) (+$0.0 m) (+$11.7 m) $201.1 m $201.1 m $207.6 m Part C (+$0.0 m) (+$0.0 m) (+$6.5 m) $75.1 m $75.1 m $76.0 m Part D (+$0.0 m) (+$0.0 m) (+$0.9 m) 21

The Ryan White HIV/AIDS Program FY2020 FY2019 FY2020 President’s Final House Request $33.6 m $33.6 m $34.0 m Part F: AETCs (+$0.0 m) (+$0.0 m) (+$0.4 m) $13.1 m $13.1 m $13.3 m Part F: Dental (+$0.0 m) (+$0.0 m) (+$0.2 m) $25.0 m $25.0 m $25.0 m Part F: SPNS (+$0.0 m) (+$0.0 m) (+$0.0 m) Ending the Epidemic Plan N/A +$70.0 m +$70.0 m 22

Centers for Disease Control FY2020 FY2019 FY2020 President’s Final House Request $788.7 m $928.7 m $945.6 m Total (+$0.0 m) (+$140.0 m) (+$156.9 m) $755.6 m $755.6 m $755.6 m HIV Prevention Division of HIV/AIDS (+$0.0 m) (+$0.0 m) (+$0.0 m) Prevention Ending the Epidemic Plan N/A +$140 m +$140 m $33.1 m $33.1 m $50.0 m School Health (+$0.0 m) (+$0.0 m) (+$16.9 m) $39.0 m $39.0 m $50.0 m Viral Hepatitis (+$0.0 m) (+$0.0 m) (+$11.0 m) $157.3 m $157.3 m $167.3 m STD Prevention (+$0.0 m) (+$0.0 m) (+$10.0 m) $135.2 $142.2 $152.3 m TB Elimination (-$7.0 m) (+$0.0 m) (+$10.1 m) $58.0 m $35.0 m Opioid Related Infectious Diseases $5.0 m (+$53.0 m) (+$30.0 m) 23

National Institutes of Health FY2020 FY2019 FY2020 President’s Final House Request $39.1 b $33.0 b $41.1 b Total (+$2.0 b) (-$6.1 b) (+$2.0 b) $3.045 b $2.621 b $3.200 b AIDS Research (+$45.0 m) (-$423.9 m) (+$155.0 m) 24

Minority AIDS Initiative Programs FY2020 FY2019 FY2020 President’s Final House Request $53.9 m $53.9 m $65.0 m Minority HIV/AIDS Fund (+$0.0 m) (+$0.0 m) (+$11.1 m) $116.0 m $116.0 m $121.0 m SAMHSA (+$0.0 m) (+$0.0 m) (+$5.0 m) 25

Housing Opportunities for Persons with AIDS FY2020 FY2019 FY2020 President’s Final House Request $393.0 m $330.0 m $410.0 m HOPWA (+$18.0 m) (-$63.0 m) (+$17.0 m) 26

Sex-Ed & Family Planning Programs FY2020 FY2019 FY2020 President’s Final House Request $286.5 m $286.5 m $400.0 m Title X (+$0.0 m) (+$0.0 m) (+$113.5 m) Teen Pregnancy $101.0 m $0.00 $110.0 m Prevention (-$101.0 m) (+$9.0 m) (+$0.0 m) Program “Sexual Risk $35.0 m $0.0 m $0.0 m Avoidance” Abstinence-Only (+$10.0 m) (-$35.0 m) (-$35.0 m) Program 27

Total Domestic HIV Programs FY2020 FY2019 FY2020 President’s Final House Request $6.903 b $7.641 b $7.059 b (-$156 m) (+$582 m) 28

“ The HIV epidemic still plagues our Nation, with more than 38,000 Americans infected every year. In response, my Budget provides $291 million to the Department of Health and Human Services to defeat the HIV/AIDS epidemic. ” - President Trump’s FY2020 Budget we do support the administration’s plan to reduce HIV transmission 90 percent in 10 years. So, we include the administration’ s request for $120 million for programs through Health Resources and Services Administration to increase access to the ground- breaking HIV drugs and $140 million for CDC’s work in HIV outreach and disease we go even further. We provide an additional $46 million for the Ryan White program. We provide additional funds for the Minority AIDs initiative. And, we provide an additional $150 million for NIH’s HIV research to secure a vaccine or a cure. “We do support the administration’s plan to reduce HIV transmission 90 percent in 10 years. So, we include the administration’s request for $120 million for programs through Health Resources and Services Administration to increase access to the ground- breaking HIV drugs and $140 million for CDC’s work in HIV outreach and disease monitoring. But, we go even further. ” -Rep. Rosa DeLauro, Chairwoman House L-HHS Appropriations Subcommittee 29